A. History taking and physical examination, including medication are important to confirm the diagnosis, assist in risk stratification, and develop a treatment plan. Important points include the following:
1. History of previous heart disease
2. Possible non-atheromatous causes of angina (eg, aortic stenosis)
3. Comorbid conditions affecting progression of CAD
4. Symptoms of systemic atherosclerosis
B. Physical examination should include a cardiovascular examination as well as evaluation for evidence of hyperlipidemia, hypertension, peripheral vascular disease, congestive heart failure, anemia, and thyroid disease.
C. Laboratory studies should include an electrocardiogram and a fasting lipid profile (total cholesterol, high-density lipoprotein, calculated low-density lipoprotein, and triglycerides). Further studies may include chest films, hemoglobin, and tests for diabetes, thyroid function, and renal function.
D. Modifiable risk factors, for coronary heart disease and comorbid factors should be addressed. Risk factors for coronary heart disease include smoking, inappropriate activity level, stress, hyperlipidemia, obesity, hypertension, and diabetes mellitus. Comorbid conditions that could affect myocardial ischemia include hypertension, anemia, thyroid disease, and hypoxemia.
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